gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Gliederung

Introduction: Although diving-accidents may occur during all phases of a dive (descent, isobaric stage, ascent) the main course of accidents is during ascent due to the development of nitrogen bubbles (DCS) or arterial embolization of air (AGE). As DCS and AGE have very similar symptoms, summarized as decompression sickness (DCI). The incidence of non-fatal diving accidents is very low (1/10.000); therefore, they are far from being routine in emergency medicine – especially in “non-diving” countries. Therefore, the main symptoms and treatment will be presented.

Treatment of DCI: Regardless whether the patient suffers from AGE or DCS apart from adequate intravenous hydration, oxygen is the only medication with a proven effect in the treatment of diving accidents. After typical diving accidents, oxygen administration at an inspired concentration (FiO2 1.0) as high as possible is recommended. All patients suspected for DCI should be transferred to a hyperbaric chamber – even if they suffer only from mild symptoms – as DCI I may develop to DCI II within a few hours. Moreover it is important to transfer the buddy of the injured diver as well (as they have performed the same diving profile and may also get symptomatic). Treatment at a hyperbaric chamber follow predefined treatment tables according to the symptoms of the patient (Figure 1 [Fig.Â 1]).